《内科学精品教学课件同济》28结核性腹膜炎英文版.ppt

Radiology thickened bowel wall with distortion of the mucosal folds and ulcerations. CT may show preferential thickening of the ileocecal valve and medial wall of the cecum and massive lymphadenopathy with central necrosis. Calcified mesenteric lymph nodes and an abnormal chest film are other findings that aid in the diagnosis of intestinal tuberculosis. At surgery: TB Reduced largely since introduction of colonoscopy Indications: Mass lesions associated with the hypertrophic form, because they can lead to luminal compromise with complete obstruction. Surgery also may be necessary when free perforation, confined perforation with abscess formation, or massive hemorrhage occur. Findings: The bowel wall appears thickened with an inflammatory mass surrounding the ileocecal region. The serosal surface is covered with multiple tubercles. The mesenteric lymph nodes frequently are enlarged and thickened. Histologically Intestinal TB: granulomas are Large, multiple, confluent with caseation Ulcers lined by epitheliod histiocytes CD Fissuring ulcer, lymphoid aggregates, transmural inflammation, and Infrequent, small, noncaseating granulomas. Am J Gastroenterol 2002;97:1446 –1451. Pulimood et al. Gut 1999 Empirical anti-TB If intestinal TB still possibility, give 4-6 weeks of anti-TB 30% of CD patietns at China receives anti-TB before final diagnosis Presumptive diagnosis can be established in A patient with active pulmonary tuberculosis and radiologic and clinical findings that suggest intestinal involvement. Response to anti-TB Thank you! * * Consumption = TB Gastrointestinal Tuberculosis Barium studies demonstrate spasm and hypermotility with edema of the ileocecal valve in the early stages Later thickening of the ileocecal valve. A widely gaping ileocecal valve with narrowing of the terminal ileum (Fleischner sign) A narrowed terminal ileum with rapid emptying of the diseased segment through a gaping ileocecal valve into a shortened, rigid, obliterated cecu